Healthcare Provider Details

I. General information

NPI: 1912924861
Provider Name (Legal Business Name): PATRICK U MEZU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MIAMI VALLEY DR
CENTERVILLE OH
45459-4774
US

IV. Provider business mailing address

PO BOX 750084
DAYTON OH
45475-0084
US

V. Phone/Fax

Practice location:
  • Phone: 937-660-6907
  • Fax: 937-350-6477
Mailing address:
  • Phone: 937-556-4324
  • Fax: 937-350-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-076704
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.076704
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: